Registration Form

• Oct 15 2010
• Dr. Martin C. Goldstein, D.M.D.
• "Comfort Zone Cosmetics: Digital Portrait to Completed Case"


• ~ 9:00 to 4:00 pm ~
• Red Bluff Community Center 1500 South Jackson St. Red Bluff, CA
• Phone: (530) 527-6764

Participants

___________________________________________________
• No refunds after October13th. $15 extra for all registration at the door.
• () $125 per CDA/ADA member dentist. Lunch included.
• () $55 per RDA/RDH/Other Dental Health Professional. Lunch included
• () $225 per non-CDA/ADA member dentist. Lunch included
• Total 7 units of C.E. credits

Method of Payment:

[ ] Credit Card [ ] Check
• [ ] Visa [ ] MasterCard
Expiration Date: MM/YY _____/______ Name of Cardholder (please print) ___________________________________________________
• Card # [ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ]
• Make Checks payable to:
• NCDS
• P.O. Box 9265
• Red Bluff, CA 96080
• Phone: 527-6764
• FAX: 527-7911

Comments

• *******************************************************************
• Dr. Goldstein currently serves on the Board of Directors for the Ark. It was at the Ark, serving underprivileged and high-risk decay patients that his interest in decay treatment options began. He is a Clinical Consultant for the University of Illinois College of Dentistry Continuing Educatin Online course on Dental Caries.